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General NPI Number Information
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NPI Number | 1730508433
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Entity Type | Individual
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Provider Name | LARISSA JONES APN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 108 W US HIGHWAY 40 STE 2
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City | TROY
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State | IL
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Zip | 62294-1836
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Country | US
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Telephone | 618-391-5065
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Fax | 618-667-2779
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Provider Business Mailing Address
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Address Line | 18 OAKDALE LAKE CIR
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City | GLEN CARBON
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State | IL
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Zip | 62034-3238
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Country | US
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Telephone | 217-821-5212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9372591
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016268
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License Number State | IL
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